Background Mental health problems can occur in patients with chronic diseases such as tuberculosis, and the stress of a pandemic exacerbates the condition. The study aims to explore the magnitude of anxiety and depressive symptoms in tuberculosis (TB) patients in community health centers (CHCs) settings during the COVID-19 pandemic. Methods The study design was quantitative and cross-sectional. Subjects were TB patients who were recruited from TB services by doctors in CHCs. TB patients (n=74) were screened for anxiety and depressive symptoms over 4 months. Screening results are uploaded on a cloud-based digital platform and analyzed. Non-TB patients, as a comparison, were recruited and screened from the same cloud-based digital platform (n=245) during the same period. Analysis was carried out using Rasch modeling for data transformation. Data was analyzed then for frequency distribution for both groups and the logistic binaries to measure the burden of the mixed anxiety and depressive symptoms among the TB patient age’s sub-group. Results In both groups, there were 48.9% of mild, moderate, and severe categories of anxiety and 63.9% of depressive symptoms. In the TB-patients group, anxiety occurred at 48.7%, of which 23% were in the moderate and severe categories, compared to 13.4% for non-TB patients. Depressive symptoms were present in 71.6% of the TB patient group, of which 28.4% were in the moderate and severe categories, compared to 15.5% of non-TB patients. TB patients aged less than 20 years experienced moderate–severe anxiety with depressive symptoms simultaneously (mixed) as much as 16.3% or 4.6 times more than those aged over 20 years (p<0.05). Conclusion Moderate and severe anxiety and depressive symptoms were shown higher in the TB patients’ group. Adolescents with TB are more susceptible to mental and emotional disorders.

Background District-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. We aimed to determine the readiness of various stakeholders to engage in implementing the DPPM strategy. Methods The research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through in-depth interviews, FGD and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in the first stage. Data were analyzed using Rasch modeling and logistic regression. Results District TB case detection rate (CDR) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were almost none from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05). Conclusions Engaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach, encourages institutional support of health facilities for the TB program and system approach.

Background: District-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. This research aims to analyze the readiness stakeholders' engagement in the context of initiating the implementation of DPPM.Methods: The research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through participant observation, in-depth interviews and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in stage I. Data were analyzed using Rasch modeling and logistic regression.Results: District TB case detection rates (CDRs) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were none or minimal from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of private facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05).Conclusions: Engaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach and encourages institutional support of health facilities for the TB program. Private sector engagement is a process that must be managed and not allowed to naturally happen.